Your Questions

Q: Dr. Eppley, I am hoping you can help me with my situation: Long story short, I had my upper lip overfilled with silicone injections years ago and I just underwent a lip reduction two months ago. Now I am left with multiple hard and misshapen lumps on my lip and I am very embarrassed about it, plus they hurt and pull as well. I am looking into some kind of injectable scar lump treatment and you seem to be the Dr. who can do it per my internet searches on the topic. The Dr. who performed my reduction thinks they will go away in time, but these are literal knots in my lips and it is by no means normal. I am worried they will never heal or “settle down”, and don’t want to take a passive route.

A: The interesting question, of course, is what are these lumps in the lip. Having done a lot of lip reductions, such lumps or irregularities are not common or expected. I would have to assume that they represent residual areas of silicone material/scar. I doubt of your lip reduction procedure removed all of the silicone material as the reduction largely removes mucosal tissue while most of the silicone is likely in the orbicularis muscle.

Injectable scar injections are not unreasonable and can have few adverse effects if not overdone. I prefer to use either low dose Kenalog or Kenalog mixed with 5-FU to treat early postoperative scar formation. Whether your lip lumps (residual areas of silicone?) will respond to such injections is uncertain but I can certainly appreciate your concern and desire to be proactive about them.

Dr. Barry Eppley

Indianapolis, Indiana

Q:   I have a scar tissue under my cheek bone caused by injecting an Artefill or Sculptra filler.  It’s been there since the filler was done 6 years ago. Now I’m been treated with 5-FU and Kenalog injections. I have done only 3 treatments so far but with no results. Do you think that the treatment can help to rescue the size of the scar or is there no hope?

A: Most likely your residual cheek mass is the result of an Artefill treatment and not Sculptra. Artefill is a filler that has a significant component of non-resorbable acrylic beads which settle into place by scar tissue forming through and around them. The beads are permanent. Sculptra is composed of resorbable poly-lactic crystals which causes temporary scar formation to occur which eventually goes away as the crystals eventually dissolve. After 6 years you have a residual mass that is, at least partly, due to the acrylic beads. While I think the 5-FU/kenalog scar injections are reasonable to try, I suspect they will ultimately prove unsuccessful as they are not going to make plastic beads disappear. Furthermore, this injectable scar treatment works best on scar that is newly forming not on established scar tissue.

That being said, 5-FU/kenalog scar injections often take a full course of treatment to know to be maximally effective. You have had only 3 injection treatments and the complete protocol is up to 10 injection sessions so it is too early to rule out completely that they will not work at all.

Depending upon the cheek mass/scar location, it may be more efficient to have it excised if it can be approached favorably through an intraoral (inside the mouth) incision.

Dr. Barry Eppley

Indianapolis, Indiana